奥希替尼致晚期肺腺癌患者心肌损伤1例

Myocardial injury induced by oxitinib in a patient with advanced lung adenocarcinoma

1例70岁男性Ⅳ期左下肺腺癌患者,应用吉非替尼治疗,服用3个月后出现耐药,改用奥希替尼。患者连续服用奥希替尼5个月后突发呼吸困难、端坐呼吸伴大汗淋漓、双下肢水肿,心电图示ST-T改变,高敏肌钙蛋白Ⅰ11025.5 pg·mL^(-1),肌酸激酶798 U·L^(-1),肌酸激酶同工酶3.1 ng·mL^(-1),N末端B型利钠肽前体3191 pg·mL^(-1),左心室射血分数从58%下降至30%,下降幅度较基线超过10%且低于正常值下限,考虑为急性心肌梗死、心力衰竭。采用诺氏药品不良反应评估量表,进行不良反应关联性评分,得分为6分,判断患者心肌损伤的不良反应“很可能”由奥希替尼引起。经停药、对症支持治疗后,心肌损伤好转。

A 70-year-old male patient with stageⅣleft lower lung adenocarcinoma was treated with gefitinib.After taking it for 3 months,the patient developed drug resistance and was treated with oxitinib instead.After 5 months of continuous administration of oxitinib,the patient suffered from sudden dyspnea,orthostatic breathing with sweating,and edema of both lower limbs.The ECG showed ST-T changes,hsTnI 11025.5 pg·mL^(-1),CK 798 U·L^(-1),CK-MB 3.1ng·mL^(-1),NT-proBNP 3191 pg·mL^(-1),and LVEF decreased from 58% to 30%,with a decrease of more than 10% from the baseline and lower than the lower limit of the normal value.It was considered as acute myocardial infarction and heart failure.The adverse reaction correlation score was 6 points by using the Roche Adverse Drug Reaction Assessment Scale.It was evaluated by Naranjo’s score scale that the adverse reaction of myocardial injury was"likely"caused by oxitinib.Myocardial injury improved after drug withdrawal and symptomatic support treatment.